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Live Vaccine Rituximab Timing — ESENeph MCQ

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ModerateRenal VasculitisLive Vaccine Rituximab TimingESENeph

A 40-year-old man with ANCA vasculitis in remission on Rituximab maintenance is planning to receive a live vaccine (yellow fever) for travel to an endemic area. When can he safely receive a live vaccine after Rituximab?

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Correct answer: A — At least 6 months after the last Rituximab dose, ideally when B-cell counts have recovered

Live vaccines are contraindicated during B-cell depletion from Rituximab. Recommendations suggest waiting at least 6 months after the last Rituximab dose and ideally confirming B-cell recovery before administering live vaccines. Non-live vaccines (inactivated) can be given but may have reduced immunogenicity during B-cell depletion. Travel planning should account for Rituximab scheduling. If travel is essential and vaccination timing cannot be achieved, alternative malaria prophylaxis and risk mitigation should be discussed.

Reference: BSR 2019 – Vaccination in Immunosuppressed; KDIGO 2024 – AAV